A Study of Inflammatory/Necrosis Biomarkers in the Fracture of the Femur Treated with Proximal Femoral Nail Antirotation

Abstract

Pertrochanteric fractures are common injuries in adults and source of morbidity and mortality among the elderly. Different surgical techniques were recommended for their treatment but undoubtedly they add an additional inflammatory trauma along the fracture itself. Many attempts to quantify the degree of approach-related trauma are carried out through measurements of systemic inflammatory parameters. In this study we prospectively analyzed laboratory data of 20 patients over eighty with pertrochanteric fracture of the femur treated with proximal femoral nail antirotation (PFNA). This is an excellent device for osteosynthesis because it can be easily and quickly inserted by a mini-incision providing stable fixation and early full mobilization. Serum tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), and plasma creatin kinase (CK) were evaluated 1 hour preoperatively and 24 hours postoperatively. Our results show that PFNA did not induce significant increments in serum levels of inflammatory cytokines TNF-α and IL-6; CRP was elevated preoperatively in correlation with waiting time for surgery; CRP and CK showed a significant increment in the first postoperatory day; CK increment was correlated with surgical time length. We conclude that, for the markers we analyzed, PFNA shows a low biomechanical-inflammatory profile that represents an advantage over other techniques.

Changes in the tumor necrosis factor-α level after an ultrasound-guided femoral nerve block in elderly patients with a hip fracture

“… 1 Moreover, geriatric patients are particularly susceptible to profound inflammatory responses to trauma that increase mortality and morbidities, including infectious complications. 2 Thus, minimizing inflammation and pain is important for reducing mortality and morbidity. An ultrasound (US) guided femoral nerve block (FNB) using a single local anesthetic injection is an established and effective analgesic method in patients with a hip fracture.…”

A comparison of two fixation methods for femoral trochanteric fractures: a new generation intramedullary system vs sliding hip screw

“…The unstable fractures are usually challenging, and several reports confirmed the superiority of nails over plates in fixation and stability (21,22,24,30). Referring to the PFNa system is reported less blood loss and shorter duration of hospitalization (31,46) and also a lower biomechanical-inflammatory profile that can be related to a lower invasiveness of the procedure (47). Other Authors reported good results also with the SHS (5,6,15,25) with the same risk of postoperative complications of PFNa (48).…”

Hepatocyte growth factor improves bone regeneration via the bone morphogenetic protein‑2‑mediated NF‑κB signaling pathway

“…Theoretically, inflammatory cytokines are crucial regulatory factors in fracture progression that are mediated by various intracellular kinase signaling pathways, and regulate the local inflammatory response following acute tibial plateau fracture (37,38). Although a previous study reported inflammatory/necrosis biomarkers in fractured femurs treated with proximal femoral nail antirotation (39), the molecular mechanism has not been clearly elaborated in previous reports. In addition, IL-6 production modulated by HGF has been investigated in bone marrow-derived macrophages; the results revealed the role of HGF in inflammatory response-mediated diseases (40).…”